profile of chinese american elders enrolled in a geriatric program at an nyc community health center...
TRANSCRIPT
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Profile of Chinese American Elders Enrolled in a Geriatric Program at an
NYC Community Health Center
10/1/2009 – 9/30/2011
APHA Annual Meeting
November 1, 2011
Charles B. Wang Community Health Center
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Presenter Disclosures
The following personal financial relationships with commercial interests relevant to this presentation
existed during the past 12 months:
Ady Oster
No relationships to disclose
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Summary Chinese-Americans are fastest-growing elderly
segment in NYC Face multiple barriers – language, poverty,
education, culture We report on our experience in caring for 230
vulnerable elders in a primary care-based geriatric practice
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Center Background Charles B. Wang Community Health Center
FQHC founded in 1971 4 locations in Manhattan and Queens
40,000 patients making >200,000 visits in 2010 90% prefer language other than English
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Manhattan’s Chinatown Pell Street, 2009
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Manhattan’s Chinatown Population 2006: 84,800
66% Asian 59% foreign-born 70% of Asians < high school education 71% elders: limited English proficiency 31%: below poverty line
Proportion of Elders in Chinatown growing: 30% increase over 10 years
Asian American Federation of New York, 2004
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Program Background Needs assessment (2006):
Chinese elders report difficulty navigating health and social service system
Increased need for health care, social services, care coordination and outreach
Medical Home for Chinese American Elders: geriatric practice serving vulnerable elderly modeled on
Patient-Centered Medical Home Two-year period Launched: October 1, 2009
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Program Background Enhanced services:
Screen for vulnerability Comprehensive geriatric assessment Psychosocial assessment Individual care plans Medication management
Service goal Screen 1,000 seniors for vulnerabilities Enroll 200 for enhanced care
Funding Program Cost: total ~ 500K Fan Fox and Leslie R. Samuels Foundation contribution: 250K
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Program Outline:
Negativen = 1,161
Negativen = 181
Comprehensive Geriatric Evaluationn = 214
Declined to participaten = 16
Positiven = 230
VES 13
Positiven = 411
Initial Geriatric Screenn =1,572
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Demographics
Male
Female
Gendern=230
98%
1%
1%
Ethnicityn=230
Chinese
Caucasian
Other
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Demographics
83%
14%
1%2%
Languagen=230
Mandarin
Cantonese
English
Other
94%
1%
1%
4%
Birth Countryn=230
China
USA
Taiwan
Other
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Demographics
*Insurance status for primary or secondary insurance
Insurance*n=230
Dual (Medicare & Medicaid), 79%
Medicare only, 3%
Managed Medicare, 6%
Private, 5%
Medicaid only, 4%
Managed Medicaid, 3%
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Assessments
Negative53%
Positive21%
Unknown26%
Unknown8%
Normal38%
Abnormal54%
Mini-Cog: Timed Get up and Go:
N= 214
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Assessments
Scale N Mean (SD)
ADL (Activities of Daily Living; Range from 0-12)
203 10.4 (2.1)
IADL (Instrumental Activities of Daily Living; Range 0-16)
201 9.6 (3.8)
K6 (Psychological Distress Assessment; Range 0-20)
177 1.63 (3.0)
SF-8 Mental Score(Quality of Life; Range 30-70; US mean = 50)
49 55.0 (5.3)
SF-8 Physical Score(Quality of Life; Range 30-70; US mean =50)
49 42.3 (9.3)
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Services Utilized:Provider Visits
Total = 2,633Mean = 11.4SD = 5.6
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Services Utilized:Social Work Visits
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Total = 1, 614 Mean = 7.0 SD = 9.1
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Services Utilized:Frequency of Mental Health Visits
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Services Utilized:Frequency of ED Visits or Hospitalizations
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Limited to those with ED/Hospital visit:
N = 29
Mean = 3.8
SD = 3.1
Overall:
Total Visits = 111
Mean = 0.5
SD = 1.7
Elders with hospital visits = 7
Elders with ED visits = 22
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Reasons for Hospitalization or ED Visits(n = 57)
20% 20%
13%
9%7%
5%4%
2%
98%
95%
89%
82%
73%
61%
41%
21%
0%
25%
50%
75%
100%
Trauma CV ID Neuro GI ONC Pulm GU Heme
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Incidence
Cummulative Incidence
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Conclusions Chinese Elders enrolled in a primary care
geriatric program
Multiple visits with providers and social workers High rates of dementia (mild), mobility difficulty,
diminished capacity performing IADL’s Low rates reported depression/other psychiatric illnesses
Low utilization of mental health services Relatively low overall utilization of ED/Hospitals
Small group of high utilizers
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Barriers: Lack of language-proficient social work
support Need for language-proficient Home Health
Aids Transportation barriers Cultural barriers accessing mental health?
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Possible Future Programs:
Patient navigation
Travel companions
Social work funding For FQHC
For patients receiving care from private MD’s
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We are grateful for the generous support from
the Fan Fox & Leslie R. Samuels Foundation
Thank You
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Team Members Clinical Director: Ady Oster, MD, MBA Program Advisor: Susan Seto-Yee, RN, MPA Program Manager: Jaclyn Tsang Physician Champion: Ginger Wey, MD Social Worker: Amanda Wong, LMSW Social Work Assistant: KC Wong Registered Nurse: Joyce Ling, RN Care Manager: Cora Toa Health Educator: Melissa Ip, RD
Contributing managerial staff: Regina Lee, JD; Manna Chan-Espin, LCSW; Tracy Wu, RN; Ida Wong; Ina Elbaar; Shao-Chee Sim, PhD; Perry Pong, MD; Betty Cheng, LCSW
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Geriatric Screening Tool
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Vulnerable Elders Survey (VES-13)
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Geriatric Assessment
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Mini-Cog Dementia Screening
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KATZ Activities of Daily Living (ADL) Scale
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LAWSON Instrumental Activities of Daily Living (IADL) Scale
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Medication Management Assessment
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Psychosocial Assessment (page 1)
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Psychosocial Assessment (page 2)
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Psychosocial Assessment (page 3)
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Emergency Room (ER) History
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Hospitalization History